Walk Registration Form
10th Annual Nassan's 5K Walk for Autism

Date: Saturday, April 27, 2024
Registration Time: 9AM - 10AM 
Location: Weequahic Park - Ron Christian Sport Complex (1 Thomas Carmichael Dr., Newark, NJ 07114)

Registration Fee: Adults $25 | Children (5-17) $15 | Children (4 & under) Free

Please Click Here to make a payment online via PayPal
or send via Zelle @info.nassansplace@gmail.com 
or Venmo @NassansPlace

For additional information call 973-424-7781 or email info.nassansplace@gmail.com

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PLEASE FILL OUT SEPERATE FORM FOR EACH PARTICIPANT
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Email *
Participant First and Last Name *
Gender *
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Team Name (if Applicable)
Address, City, State, Zip *
Phone *
T-Shirt Size *
Registration Fee Adults: 18 and over $25.00  Children: age 5 - 17 - $15.00 (4 & under - Free) Registration fee includes T-Shirt                                          Registration Deadline: April 21, 2023 Click Here to make payment online  or send via Zelle @info.nassansplace@gmail.com 
or Venmo @NassansPlace
or mail checks and money orders payable to “Nassan’s Place” to the following address: Nassan’s Place, Inc., 
P.O. Box 833   East Orange, NJ  07019
Release - In consideration for the opportunity to participate in the “10th Annual Nassan 5K Walk for Autism”  I agree as follows for myself, and for my child(ren) who participate and/or attend with me: I hereby waive and release, for myself, my child, my heirs, executors and administrators, any and all rights, claims, liabilities and causes of action whatsoever I or my child may have against Nassan’s Place, Inc ., its affiliates and the "10th Annual Nassan 5K Walk for Autism” operators and sponsors and each of their respective officers, directors, employees and agents (the “Event Parties”) relating to or arising from my or my child’s participation in the Event, including but not limited to personal injury.  I. recognize the “10th Annual Nassan 5K Walk for Autism” has inherent risk of injury and I hereby assume that risk, and on behalf of me and my child. If I or my child causes injury to any person or damage to any property while participating in the Event, I hereby indemnify and hold harmless the Event Parties from and against any and all claims, suits, actions, loses, damages and expenses related to or arising from such injury or damage.  I hereby give my consent to Nassan’s Place, Inc., to use my and my child’s name and photographs, video and film (“Photos”) of me and/or my child taken before, during or after the “10th Annual Nassan 5K Walk for Autism” in advertising and promotional materials for Nassan’s Place, including but not limited to the Internet, without compensation. I agree that no advertising or other material need be submitted to me or my child for approval. I agree that all Photos of me and/or my child used by Nassan’s Place, Inc. and they may copyright material containing same. I hereby release, discharge, and agree to save harmless the Event Parties from any liability, including, without limitation, any claims for libel or invasion of publicity/privacy, by virtue of any use of my or my child’s name and/or Photos, including, any alteration of such Photos, whether intentional or otherwise. I have read and understand this Release and Consent and declare all information is truthful and accurate. *
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